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Body mass index and prognosis in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease.

Lainscak M, von Haehling S, Doehner W, Sarc I, Jeric T, Ziherl K, Kosnik M, Anker SD, Suskovic S - J Cachexia Sarcopenia Muscle (2011)

Bottom Line: Lowest mortality was found for BMI 25.09-29.05 kg/m(2).In an adjusted model, BMI per 1 kg/m(2) unit increase was associated with 5% less chance of death (hazard ratio 0.95, 95% confidence interval 0.93-0.97).A better outcome in obese patients compared to normal weight is in contrast to primary prevention data but concurs with observations of an obesity paradox in other cardiovascular diseases.

View Article: PubMed Central - PubMed

ABSTRACT
BACKGROUND: Nutritional status, weight loss and cachexia have important prognostic implications in patients with chronic obstructive pulmonary disease (COPD). Body mass index (BMI) has been implicated in COPD risk assessment, but information is mostly limited to composite scores or to patients with stable disease. We aimed to analyse the association between BMI and mortality in acute exacerbation of COPD. METHODS: This retrospective survey included 968 patients hospitalized due to acute exacerbation of COPD at the University Clinic Golnik from February 2002 to June 2007. Vital status was ascertained with Central Population Registry, and database was censored on November 1, 2008. RESULTS: Median BMI was 25.08 kg/m(2) (interquartile range, 21.55-29.05 kg/m(2)) and 210 patients (22%) had BMI < 21 kg/m(2). During median follow-up of 3.26 years (1.79-4.76 years), 430 patients (44%) died. Lowest mortality was found for BMI 25.09-29.05 kg/m(2). When divided per BMI decile, mortality was lowest for BMI 25.09-26.56 kg/m(2) (33%). In univariate analysis, BMI per quartile and BMI per unit increase were predictive for all-cause mortality. In an adjusted model, BMI per 1 kg/m(2) unit increase was associated with 5% less chance of death (hazard ratio 0.95, 95% confidence interval 0.93-0.97). CONCLUSIONS: Low BMI < 21 kg/m(2) is frequent in patients hospitalized due to acute exacerbation of COPD. Higher BMI was independently predictive of better long-term survival. A better outcome in obese patients compared to normal weight is in contrast to primary prevention data but concurs with observations of an obesity paradox in other cardiovascular diseases.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier survival curves per body mass index quartiles and univariate analysis of mortality. HR hazard ratio, CI confidence interval
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Fig1: Kaplan–Meier survival curves per body mass index quartiles and univariate analysis of mortality. HR hazard ratio, CI confidence interval

Mentions: During follow-up (median 3.26 years; range 1.79 to 4.76 years), 430 patients (44%) died. Mortality rates at year 1, 2, and 3 after discharge were 12% (95% confidence interval [CI] 10-15%), 25% (21-26%), and 32% (29-35%), respectively. Lowest mortality was found for patients in third BMI quartile (25.09–29.05 kg/m2) and increased to lowest BMI quartile—Table 1 and Fig. 1. When patients were divided per BMI decile, mortality was lowest for those with BMI of 25.09–26.56 kg/m2 (33%). A linear increase was observed for patients below optimal BMI decile (a relative risk of 1.94 for patients with BMI < 18.42 kg/m2), whereas risk plateaued with increasing BMI—Fig. 2.Fig. 1


Body mass index and prognosis in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease.

Lainscak M, von Haehling S, Doehner W, Sarc I, Jeric T, Ziherl K, Kosnik M, Anker SD, Suskovic S - J Cachexia Sarcopenia Muscle (2011)

Kaplan–Meier survival curves per body mass index quartiles and univariate analysis of mortality. HR hazard ratio, CI confidence interval
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3118008&req=5

Fig1: Kaplan–Meier survival curves per body mass index quartiles and univariate analysis of mortality. HR hazard ratio, CI confidence interval
Mentions: During follow-up (median 3.26 years; range 1.79 to 4.76 years), 430 patients (44%) died. Mortality rates at year 1, 2, and 3 after discharge were 12% (95% confidence interval [CI] 10-15%), 25% (21-26%), and 32% (29-35%), respectively. Lowest mortality was found for patients in third BMI quartile (25.09–29.05 kg/m2) and increased to lowest BMI quartile—Table 1 and Fig. 1. When patients were divided per BMI decile, mortality was lowest for those with BMI of 25.09–26.56 kg/m2 (33%). A linear increase was observed for patients below optimal BMI decile (a relative risk of 1.94 for patients with BMI < 18.42 kg/m2), whereas risk plateaued with increasing BMI—Fig. 2.Fig. 1

Bottom Line: Lowest mortality was found for BMI 25.09-29.05 kg/m(2).In an adjusted model, BMI per 1 kg/m(2) unit increase was associated with 5% less chance of death (hazard ratio 0.95, 95% confidence interval 0.93-0.97).A better outcome in obese patients compared to normal weight is in contrast to primary prevention data but concurs with observations of an obesity paradox in other cardiovascular diseases.

View Article: PubMed Central - PubMed

ABSTRACT
BACKGROUND: Nutritional status, weight loss and cachexia have important prognostic implications in patients with chronic obstructive pulmonary disease (COPD). Body mass index (BMI) has been implicated in COPD risk assessment, but information is mostly limited to composite scores or to patients with stable disease. We aimed to analyse the association between BMI and mortality in acute exacerbation of COPD. METHODS: This retrospective survey included 968 patients hospitalized due to acute exacerbation of COPD at the University Clinic Golnik from February 2002 to June 2007. Vital status was ascertained with Central Population Registry, and database was censored on November 1, 2008. RESULTS: Median BMI was 25.08 kg/m(2) (interquartile range, 21.55-29.05 kg/m(2)) and 210 patients (22%) had BMI < 21 kg/m(2). During median follow-up of 3.26 years (1.79-4.76 years), 430 patients (44%) died. Lowest mortality was found for BMI 25.09-29.05 kg/m(2). When divided per BMI decile, mortality was lowest for BMI 25.09-26.56 kg/m(2) (33%). In univariate analysis, BMI per quartile and BMI per unit increase were predictive for all-cause mortality. In an adjusted model, BMI per 1 kg/m(2) unit increase was associated with 5% less chance of death (hazard ratio 0.95, 95% confidence interval 0.93-0.97). CONCLUSIONS: Low BMI < 21 kg/m(2) is frequent in patients hospitalized due to acute exacerbation of COPD. Higher BMI was independently predictive of better long-term survival. A better outcome in obese patients compared to normal weight is in contrast to primary prevention data but concurs with observations of an obesity paradox in other cardiovascular diseases.

No MeSH data available.


Related in: MedlinePlus